Specialty Therapies for Wound Care Diane L. Krasner PhD, RN, FAAN & Lia van Rijswijk DNP, MSN, RN, CWCN   Module #11

Objectives To describe the use of Specialty Therapies to augment, supplement or enhance usual wound care To appraise the role of nurses when specialty therapies are used for wound care

Specialty Therapies for Wound Care Modalities used to augment, supplement or enhance usual wound care may be selected to: - Help meet goals of patient care (e.g., contain exudate, reduce odor) - Facilitate healing (e.g., when wound fails to heal using moisture retentive dressings) Krasner DL, Sibbald RG, Woo KY, Norton L. (2012) Interprofessional Perspectives on Individualized Wound Device Product Selection. WoundSource White Paper. Kestrel Health Information. Downloadable at www.woundsource.com

Also described as: - Adjunctive Therapies - Alternative Therapies Negative Pressure Wound Therapy followed by Delayed Primary Closure Photos by Dr. Diane L. Krasner, Used with permission

Selection / use often linked to a Healthcare Specialty: Examples: Hyperbaric Oxygen Therapy (HBOT) - Hyperbaric Physicians, Nurses, Technicians, Respiratory Therapists Pulsed Lavage - Surgeons, Podiatrists Warriner RA, Wilcox JR, Barry R. (2014) The Role of Oxygen and Hyperbaric Medicine. In: Krasner, D.L. (Ed). Chronic Wound Care: The Essentials. Malvern, PA., HMP Communications . Downloadable at www.WhyWoundCare.com/Resources

Selection/Use Often Linked to a Healthcare Specialty: Examples (continued): Electrical Stimulation and Pulsed Electromagnetic Field Therapy - Physical Therapists, Nurses Ultrasound - Physical Therapists

Many Specialty Therapies for Wound Care Involve the Use of Devices that Require Special Guidelines for Use: Example: Negative Pressure Wound Therapy (NPWT) FDA Safety Alert. Negative Pressure Wound Therapy (NPWT) Systems – Preliminary Public Health Notification. U.S. Food and Drug Administration Website. Published February 24, 2011. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm190704.htm FDA Safety Communication. Update on Serious Complications Associated with Negative Pressure Wound Therapy Systems. U.S. Food and Drug Administration Website. Published February 24, 2011. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm244211.htm

Always Review Medical Device: Indications Contraindications Precautions (warnings) Guidelines for Use Smith APS, Whittington K, Frykber R, de Leon JM. (2014) Negative Pressure Wound Therapy. In: Krasner, D.L. (Ed). Chronic Wound Care: The Essentials. Malvern, PA., HMP Communications . Downloadable at www.WhyWoundCare.com/Resources

Examples of Contraindications and Precautions: NPWT should not be used for debridement - remove slough and eschar from the wound bed prior to using NPWT. NPWT should be used with caution in patients who are on anti-coagulation therapy or when vital structures are exposed. Implement measures to protect against backsplash when using high pressure irrigation (pulsed lavage). Brady, EH. Strategies for the effective management of challenges associated with negative pressure wound therapy. 2014. WoundSource White Paper. Kestrel Health Information. Available at www.woundsource.com Beitz J.M. & van Rijswijk, L. Developing Evidence-Based Algorithms for Negative Pressure Wound Therapy in Adults with Acute and Chronic Wounds: Literature and Expert-based Face Validation Results. Ostomy Wound Manage 2012; 58(4),50-69. Available at http://www.o-wm.com/content/developing-evidence-based-algorithms-negative-pressure-wound-therapy-adults-acute-and-chroni

Nurses’ Roles with Specialty Therapies for Wound Care include: Monitoring the patient and the wound status (including surrounding skin) Monitoring device function (e.g. NPWT, HBOT) Applying certain device dressings (e.g. NPWT) Assisting with the delivery of treatments (HBOT) Educating patients and their Circle of Care

Nurses’ Assess/Monitor for & Report Complications: Examples: Changes in patient status (e.g., changes in vision following HBOT) Pain Delayed wound healing / increasing wound size Bleeding Device malfunction

SAFETY IS THE #1 CONCERN REMEMBER: Device-related adverse events should be reported to manufacturer or the United States Food and Drug Administration at: http://www.fda.gov/Safety/MedWatch/HowToReport/default.htm

Caution: Off-label Use of Devices Know your Facility Chain-of-Command

Communication & Documentation of: Device Specifics & Dressing Details (Physician Order Usually Required) Example for NPWT: Specific device type & brand Continuous or intermittent Pressure setting Dressing change frequency Type of foam/gauze used Type of interface dressing used Type of cleansing solution used Type of pain medication/pre-medication

Device Use Issues Cost Access Knowledge/Skills of Patient and his/her Circle of Care Prescriber Knowledge Evidence-based Practice Healthcare Staff Education

“Five Rights” Right dressing materials Right device (& orders) Right dressing materials Right teaching/learning (documented) Right instructions (in writing) Right communication & transitions of care

Key Nursing Concepts Assessment Caring Communication Education Evidence-based Practice Healing Pain Safety Treatment

Key Nursing Diagnoses Alteration in Comfort r/t Impaired Skin Integrity Impaired Tissue Integrity Potential for Injury Knowledge Deficit r/t Self Care Deficit r/t

Key Nursing Practice Issues When using NPWT, always cleanse the wound before applying a new dressing (foam or gauze) and drape. Stay within your scope of practice. Communicate with your supervisor or use your facility chain-of-command if you are concerned about the use of a device, the patient/wound response or if you are concerned that you are practicing outside your scope of your practice.

Websites for Further Information on Types of Wounds - Association for the Advancement of Wound Care www.aawc1.org - Canadian Association for Wound Care www.cawc.net - National Pressure Ulcer Advisory Panel www.npuap.org - World Union of Wound Healing Societies www.wuwhs.org - Wound Ostomy Continence Nurses Society www.wocn.org

www.WhyWoundCare.com